Treatments for Menopause
When women transition into menopause, many of them experience symptoms related to the changes in estrogen and progesterone hormone levels. These symptoms may include hot flashes, mood changes, forgetfulness or trouble concentrating, vaginal dryness, sleep problems, sweating at night, or bladder issues such as a loss of control.
What types of treatments are available to help manage these symptoms?
There are a range of treatments available, and they may be given by mouth, on the skin or into the vagina. Many products contain a hormone such as estrogen or a combination of estrogen and progesterone, but other non-hormonal medications also are used to treat menopausal symptoms. You should discuss your symptoms with your doctor to work together to find a suitable treatment.
What treatment is best for hot flashes?
Estrogen-containing medications are the most effective medication for management of hot flashes, night sweats, and other symptoms as estrogen addresses the decrease in this hormone that occurs during menopause. For this use, estrogen is available as tablets to take by mouth, as patches to place on your skin that release the medication slowly, as a spray or gel to place on the skin daily, and as a ring to place in your vagina. If you never had a hysterectomy and still have a uterus, your doctor may also recommend taking combination hormone therapy, progesterone along with estrogen, to decrease the risk of cancer of the uterus. Progesterone may be combined with estrogen in the same product or taken separately.
Non-hormonal treatments for hot flashes include the use of certain antidepressants (Celexa®, Lexapro®, Brisdelle ®, Lyrica®, and Effexor®) and medications that act on the central nervous system such as gabapentin (Neurontin®) and pregabalin (Lyrica®).
What treatments are available for vaginal dryness and bladder issues?
For management of these symptoms, estrogen-containing products (cream, tablets, vaginal rings) can be placed directly into the vagina. This allows the medication to act locally and is used in lower doses to reduce risks associated with oral estrogen therapy. A non-estrogen medication (Osphena®) can also be used to treat these symptoms but should not be used by women having previously had medical issues such as blood clots, cancer, stroke, or heart attacks. Other non-estrogen treatments, such as vaginal moisturizers (Replens®) which are available without a prescription, can also be used to treat vaginal dryness.
What are the risks of hormone treatments?
Clinical studies have shown risks associated with hormonal (estrogen, progesterone) treatment include heart disease, breast cancer, gallbladder disease, stroke, and blood clots. Also taking estrogen alone (without progesterone) increases the risk of cancer of the uterus. Women who have had breast cancer, liver disease, a stroke, heart attack, or a blood clot should probably not take estrogen medications.
How can hormone treatment risks be decreased?
All estrogen medications should be given at the lowest effective dosage for the shortest duration necessary to improve symptoms. Some experts recommend beginning hormone therapy early in menopause and discontinuing several years later as symptoms decrease. Women with risk factors should discuss the use of hormone therapy with their doctor.
I’ve heard about bioidentical hormones, are they better to use?
Bioidentical hormones come from plant sources that are similar to those produced by the body. Many advertised bioidentical hormone products are compounded by a pharmacist. Custom compounded products can vary in strength and purity of the medication and do not reduce risks associated with hormone therapy. FDA-approved bioidentical hormone medications are available. The American College of Obstetricians and Gynecologists (ACOG) recommend the use of FDA-approved products rather than custom compounded products due to limited information about safety and efficacy.
Are herbal products better to use?
There are several herbal or natural products available to treat menopausal symptoms such as soy, black cohosh, or omega-3 fatty acid supplements. However, there are very few clinical studies evaluating the use of these products to demonstrate their effectiveness or long-term safety. Ask your pharmacist for more information about these products.
Summary
Medications for management of menopausal symptoms should be carefully considered based on the individual’s symptoms and risk factors. If you are considering treatment for your menopausal symptoms, talk with your doctor and pharmacist to find the treatment that is best for you.